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Arrest Disorders and Infant Brain Damage

From the Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, The Presbyterian Hospital, New York, New York; the Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland; and Cleveland Metropolitan General Hospital, Cleveland, Ohio

Abstract

In the past, difficult labors have been associated with maternal and infant damage. Today, changing patient management is associated with less trauma and more frequent use of cesarean births to avoid potential fetal neurologic damage. In this report, arrests of dilatation and descent and prolongation of the decelerative phase of labor were reviewed with respect to the later appearance of brain damage in infants after 2 years of age, in association with obstetric interventions including cesarean birth, forceps, and oxytocin. Charts of 413 infants born after abnormal labors were studied. Log-linear analysis was performed to determine the contribution of method of delivery and oxytocin use to the presence of neurologic abnormalities. Statistical testing ruled out the presence in the model of a three-way interaction, and excluded the two-way interactions of neurologic abnormalities-oxytocin use and neurologic abnormalitiesmethod of delivery. Chi-square tests of partial association and marginal association for the delivery-oxytocin interaction yielded values of 33.54 (P<.0001) and 33.78 (P<.00001). This model asserted that method of delivery and use of oxytocin were unrelated to the presence of neurologic abnormalities, but were related to each other. (Obstet Gynecol 74:321, 1989)